Why melasma gets Potenza alongside laser toning, not toning alone

When people think of melasma treatment, most think of laser toning first. It fires a low-energy laser over several sessions, which makes it the basic treatment for a sensitive pigment like melasma. Some people, though, have had several toning sessions, see less fading than they hoped, and ask what else there is.

Looking back at people treated for pigment at our clinic, those who also had Potenza were more satisfied. Those who had toning alone were more often disappointed.

Whether to stay with toning or add another treatment depends on how the melasma has settled in the skin. What is usually called toning tends to work on melasma that sits in small patches.

Melasma that has settled in larger and is not enough for toning alone does not just get more toning. Where needed, a treatment that helps cells turn over from deeper in the skin, such as Genesis toning or Potenza, is recommended alongside it.

Many people arrive having heard that "the laser breaks up the pigment". That is not wrong, but if that is all you know about melasma it is easy to think the answer to slow fading is a stronger shot.

Melasma is now understood less as pigment piled up in the skin and more as overactive pigment-making cells (melanocytes). These cells pass melanin to the cells around them through branch-like dendrites, and in skin with melasma those dendrites are often more numerous or longer.

When the energy is too high or the exposure too long, heat that should stay in the pigment spreads into the surrounding tissue. That heat damage stimulates the melanocytes again and increases inflammation, and the pigment can end up darker. So when melasma fades slowly, the energy is not raised for another round.

Potenza is better known for acne scars and pores. When the same device is used for melasma, the tip and the settings are different.

Melasma gets the N tip (non-insulated), where the whole needle is the electrode. The radiofrequency comes out evenly along the length of the needle, so instead of burning one point hard it warms a wide area gently. In the process, blood vessels settle, inflammation goes down and the dermis is rebuilt.

The time the radiofrequency is held (ms) is set differently as well. For acne or scars, where one point needs to change strongly, it is kept short. For melasma, where regeneration and calming inflammation matter more than breaking down tissue, it is set long so that the heat spreads slowly into the surrounding area.

A systematic review published this year gathered 12 studies of radiofrequency microneedling such as Potenza for melasma (Aesthet Surg J Open Forum 2026, PMID 42253423). Melasma scores and melanin indices generally improved, with effects lasting up to 6 months. Post-inflammatory hyperpigmentation was uncommon even in darker skin, and pigment fell further when it was combined with a low-fluence Q-switched Nd:YAG laser (toning) than with either alone.

The studies differed in who and how they treated, so the review could not pool the numbers and summarised them qualitatively. Even so, it points the same way as adding Potenza rather than repeating toning alone.

A few months after treatment stops, it is common for melasma that had faded to come back. That is why melasma care is closer to keeping it faint than to removing it. Adding Potenza does not change that.

A team at Ajou University Hospital in Korea gave people with melasma oral tranexamic acid and a triple-combination lightening cream for two months, then stopped the drugs and continued radiofrequency microneedling on one half of the face once a month for six months (Sci Rep 2024, PMID 38200171). During the two months on the drugs, everyone's melasma score fell by 64%. Afterwards the side that kept getting radiofrequency held its improvement, while skin brightness on the untreated side gradually returned to where it started.

Fifteen people took part and eleven finished, so it is a small study. Read it as a sign that treating the dermis may help slow melasma coming back, and no more.

When you show a brown patch on your face, the first thing checked is whether it is melasma or a lentigo. A lentigo does not spread like a haze the way melasma does; it is a brown spot with a fairly clear edge.

Where a lentigo has darkened, it is reduced with a CO2 laser first and then toned. A solar lentigo, caused by sunlight, does not clear in one or two sessions, so it usually takes several rounds of Potenza alternating with toning.

Because it needs many visits, it is hard to readily suggest starting it to someone who lives far from the clinic and cannot come often. If you are visiting Korea for a short stay, a solar lentigo is not something to plan around a single trip.